How Effective Are Breast Feeding Policies?

Breast feeding has been rather consistently associated with a lower risk of childhood obesity (and better post-partum weight loss in mothers).

Unfortunately, what was well intended by mother nature has long been widely abandoned (or shortened) to suit our rather unnatural lifestyles.

Is this a trend that can be reversed?

A paper by Sara Kirk and colleagues from the University of Dalhousie, Halifax, now examine the lessons learned from the implementation of a provincial breastfeeding policy in Nova Scotia and the possible implications for childhood obesity prevention, in the International Journal of Environmental and Public Health.

In recognition of breastfeeding as the optimal mode for infant feeding and a critical factor in promoting infant health, in 2005, the Canadian province of Nova Scotia introduced a provincial breastfeeding policy.

The policy applies to the provincial government Department of Health and Wellness, District Health Authorities and all health system funded providers. The policy comprises ten directives designed to promote breastfeeding initiation and duration in Nova Scotia and to provide supportive environments for breastfeeding mothers. These directives include the need for leadership and support for breastfeeding throughout the province, along with monitoring and evaluation of the policy.

For their study, the researchers conducted focus groups with members of provincial and district level breastfeeding committees who were tasked with promoting, protecting and supporting breastfeeding in their districts.

These discussions revealed five comon themes that posed barriers to the full implementation of this policy: an unsupportive culture of breastfeeding; the need for strong leadership; the challenges in engaging physicians in dialogue around breastfeeding; lack of understanding around the International Code of Marketing of Breast-milk Substitutes; and breastfeeding as a way to address childhood obesity.

Of these, the most pervasive and consistent barrier was that faced by mothers in a culture that is generally unsupportive of breast feeding. As the authors note:

“This unsupportive culture of breastfeeding was viewed as a barrier to breastfeeding across the continuum of care, but most especially beyond six months, or when women returned to work. Specifically, the perceived lack of a supportive environment was reflected in participants’ anecdotal accounts of breastfeeding, both in the workplace and in the broader community. While participants felt that breastfeeding mothers were philosophically supported to breastfeed when they returned to work, the practical reality of needing to pump or breastfeed at work was not seen as particularly well supported.”

This unsupportive culture was clearly evident from some of the quotes in the article:

“I tried with my first [baby] pumping when I came back and it did not work because…when there’s work to be done, people don’t look real friendly at you if you’re running off with a pump and you’re doubling up work for somebody else while you’re gone, so if you actually get a break you could run and do it…”

“…and this isn’t being judgmental either but there’s not one staff member in our facility that smokes that does not get three or four extra smoke breaks during the day and they don’t take those on their lunch breaks and their coffee breaks, they’re never questioned when they want to go out for a smoke…but granted, it doesn’t take as long to have your cigarette as it does to nurse a baby, but it’s just the whole thought process around it, like people don’t view that as a hindrance to your working life as much as they would to sneak off and feed baby”

“We’ve got to change the minds, the culture has to change because even nursing at 22 months I was getting to the point, and I know I shouldn’t have been, but to the point where I felt I had to hide it. I had to hide it from my mother because she’d say ‘oh my god you’re too old to be breastfeeding this child’, or ‘she’s too old to be breastfeeding’, but you get to the point where you feel you have to hide it because it’s not normal, it’s not considered normal to others”

This is not to say that the other themes were likewise relevant.

However, cultural acceptance of breast feeding (in public) is something that appears to be completely lacking in North America. While back in Europe, no mother would think twice about laying bare her breast to feed her infant in public (and no one would consider this anything but completely normal), it is almost hilarious to note the ridiculous fuss that people here in Canada seem to make about this.

In Europe, where parents are slightly embarrassed to be seen offering their kids a bottle in public, the opposite is true. But things are changing there too – and not for the better.

Thus, although the authors note that

“…promotion of breastfeeding offers a population-based strategy for addressing the childhood obesity epidemic and should form a core component of any broader strategies or policies for childhood obesity prevention.”,

I am less than optimistic that we will see widespread movements to breast feed infants for as long as nature intended. Unfortunately, policies cannot change culture – rather, changes in culture change policies.

I’d certainly like to hear my readers’ views on this issue. What are the perceived barriers to breast feeding and how do you think they could be addressed?

Edmonton, Alberta

ResearchBlogging.orgKirk SF, Sim SM, Hemmens E, & Price SL (2012). Lessons learned from the implementation of a provincial breastfeeding policy in nova scotia, Canada and the implications for childhood obesity prevention. International journal of environmental research and public health, 9 (4), 1308-18 PMID: 22690194